Jennifer L. Kuk
Adults with mild to severe obesity can obtain metabolic health benefits with physical activity and healthy fitness behaviors while remaining obese, study data show.
“The most important finding is that you cannot judge your patient’s fitness or health by simply looking at their body weight,” Jennifer L. Kuk, PhD, associate professor in the School of Kinesiology and Health Science at York University in Toronto, told Endocrine Today. “Your patients can be physically active and not lose weight, but it is likely still going to be beneficial for their health. It is important for you and your patient to disconnect success with only what you see on the scale.”
Kuk and colleagues evaluated data on 853 adults from the Wharton Medical Clinic to determine the relationships between fitness and metabolic risk factors in individuals with higher levels of obesity.
BMI levels were categorized as mild obesity (BMI 34.9 kg/m2), moderate obesity (BMI 35 kg/m2 to 39.9 kg/m2) and severe obesity (BMI 40 kg/m2). Age- and sex-specific VO2 max cutoffs were used to define fitness: unfit (< 20th percentile) or fit ( 20th percentile). Participants were divided into six groups based on fitness status and BMI: fit with mild obesity (n = 107; mean age, 51 years; 80.4% women), unfit with mild obesity (n = 151; mean age, 54.8 years; 75.5% women), fit with moderate obesity (n = 60; mean age, 43.9 years; 90% women), unfit with moderate obesity (n = 181; mean age, 53.5 years; 77.9% women), fit with severe obesity (n = 38; mean age, 44 years; 86.8% women) and unfit with severe obesity (n = 316; mean age, 48.5 years; 75% women).
Metabolic profiles were significantly worse in participants with severe obesity regardless of fitness compared with the fit with mild obesity group (P < .05) and the unfit with mild obesity group (P < .05).
Differences in waist circumference between the fitness groups were greater in men (P = .06) and women (P = .0005) in the higher obesity classes. Waist circumference differences reached significance only in women with moderate obesity (fit, 112.1 vs. unfit, 116.5 cm; P = .001) and severe obesity (fit, 119.6 cm vs. unfit, 129.2 cm; P < .0001).
Compared with the mild obesity group, regardless of fitness, the unfit moderate and severe obesity groups had increased RRs for preclinical hypertension, hypertriglyceridemia and hypoalphalipoproteinemia and prediabetes (P < .05).
“We are starting to realize that obesity and weight management is much more complicated and difficult than telling patients to eat less and move more,” Kuk said. “Better work is needed to understand the drivers to obesity-related metabolic conditions and how best to treat them once they are present. Part of that is recognizing that each patient will be unique in how they arrived at their condition, what their goals and circumstances are and how best to treat their condition.
“Part of the issue with obesity management is that we do not yet have the interventions to match the patient expectations for weight loss, and so clearly that is an issue that needs further research,” she said. “However, the other issue is that bias and discrimination that individuals with obesity face and how that may drive them to more drastic and potentially unhealthy weight-loss strategies. Work is also needed on how best to change public opinion on obesity.” – by Amber Cox
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Jennifer L. Kuk, PhD, can be reached at email@example.com.
Disclosures: Kuk reports no relevant financial disclosures. One researcher reports he is the founder and an employee of the Wharton Medical Clinic.